2.  Today we will be covering:  What is orthopedics?  What are bones?  How to classify bones  Fractures!  How to repair a fracture  A quick look at current research involving bones  All of this information is true for people and pets! What are we going to learn?

3. That branch of medicine and surgery that is specially concerned with the preservation and restoration of the function of the skeletal system, its joints, and associated structures like ligaments and tendons Orthopedics Defined

4. 1.Support/protection for body’s vital organs (for example, skull protects the brain, rib cage protects the heart & lungs) 2.Serve as levers in conjunction with joints, tendons, ligaments, and muscles for movement 3.Production of blood cells in bone marrow 4.Storage site for calcium & phosphorus What Do Bones Do?

5. Two Types of Bone: 1.Compact Bone: bone’s outer layer, what we can see. It is dense, strong, and heavy 2.Spongy Bone – bone’s inner layer; self- organizes in response to the direction of weight put on it Anatomy of a Typical Bone

6.  Joint – where two or more bones come together  Joint Cartilage – cartilage covering the ends of bones that are in contact with adjacent bones to allow smooth movement and shock absorption  Tendon – connects muscle to bone  Ligament – connects bone to bone Associated Structures

7.  Long – long! Bones of limbs  Short – short! Small bones of hands & feet  Flat – flat! Bones on top of skull  Sesamoid – small bones embedded in tendon as it crosses a bony prominence. Found in digital tendons.  Irregular – jutting processes give these bones an irregular shape. Found in pelvic bone. Classification of Bones

8. Can you identify what type of bones these are?  flat bones  sesamoid bone (and its associated tendon)  short bones  irregular bone Quiz!

9.  Your bones are living tissue!  Cells called osteoclasts break down old bone.  Cells called osteoblasts replace it with new tissue. Living Tissue

10.  Osteoblasts – secrete a matrix made up of calcium phosphate crystals. “Blasts Build up Bone”.  Osteocytes – retired osteoblasts; found within bony wall that they have deposited around themselves.  Osteoclasts – break down bone; release acids to dissolve crystals and enzymes to break down matrix. “Clasts Clash Bone”. Bone Remodeling

11.  Goes on throughout life  10-30% of adult bone is re-built every year  Bones of femur completely rebuilt every 6 months  Bones in skull may take 10 years to re-build  Drink your milk (and sunshine for vitamin D) Bone Remodeling Fun Facts

12.  Wolff’s Law: Greater physical stress placed on a bone at a particular site results in more bone deposition by osteoblasts at that site  Examples:  Astronauts who spend a long time in space will often return to Earth with weaker bones, since gravity hasn't been exerting a load on their bones. Their bodies have reabsorbed much of the mineral that was previously in their bones  Weightlifters often display increases in bone density in response to their training. Bone Reacts to Stresses Put on It

13. FRACTURES A medical condition in which there is a break in the continuity of the bone.

14. What is a radiograph? Radiographs are: The image produced on a film by X-rays or other forms of radiation. X-Rays are: Electromagnetic radiation of short wavelength produced when high-speed electrons strike a solid target. X-Rays produced here! X-Rays travel here! X-Ray film here!

15. Radiograph FAQ’s! Does it hurt the animal? Not at all! They are totally painless, you cannot see or feel the X-Rays! Are they safe? Yes, the dose of radiation used is the smallest possible to make a diagnostic image. Anyone regularly working around X-Rays must wear a dosimeter that tracks their total exposure.

16. Name The Animal!

17. What Did the Snake Eat?

18. Human Vs. Dog

19. Normal Dog Images!

20. Closed Fracture  A broken bone that does not penetrate the skin.  Also known as a simple fracture.

21. Open Fracture  A broken bone that penetrates the skin.  Also known as a compound fracture.  Needs immediate treatment, and an operation is often required to clean the area of the fracture.  Higher risk of infection and more problems associated with healing.

22. Complete Fracture  A fracture in which bone fragments separate completely.

23. Normal Fracture Healing White zone is area of new bone deposit

24.  Mal-union – a fracture that heals with abnormal alignment  Non-union – fracture healing has STOPPED before the bone is completely healed  elephant foot “hypertrophic non-union”  tapered “atrophic non-union”  Osteomyelitis – infection of bone Abnormal Fracture Healing

25. Malunion In the wristIn the elbow  Mal-union – a fracture that heals with abnormal alignment

26. Non-union  Hypertrophic non-union is a bulging appearance at the fracture site, which results from a large amount of callus formation. Usually caused by to much mobility at fracture site, blood supply is adequate.  Atrophic non-union is narrow, rounded ends of bone at the level of the fracture. This is caused by a poor healing response due to a lack of blood supply.

27. Osteomyelitis Osteomyelitis – infection of bone

28.  Get bones close enough together to heal correctly  Proper alignment  To Avoid:  mal-union  loss of function  additional trauma  further fracture  infection Fracture Reduction Goals

29. Fracture Reduction  Closed  Permanent (cast or splint)  Temporary (until surgery)  Open (orthopedic surgery)  Intramedullary Fixation (Pins)  Cerclage (Wires)  External Fixation Devices Treatment Options

30. Closed Fracture Reduction Use of a bandage or splint to heal the fracture. Can be temporary or permanent.

31. Open Fracture Reduction An open fracture reduction involves cutting through the skin to realign the bones. Normally this is used if the bone is in many pieces or is difficult to reduce.

32. Intramedullary Fixation Intramedullary fixation is the use of pins, they come in a variety of sizes. You pick the pin based upon the bone itself, the animal, and the location.

33. Pin Insertion The pin is inserted with a hand chuck in order to hold the fractured bone in the correct location.

34. Cerclage Cerclage: encircling the bone with a wire ring or loop, as for fixation of fragments in a fractured bone

35. External Fixators The process of installing temporary repair supports outside of the skin to stabilize and align bone while the body heals.

36. External Fixators

37. Surgery Tools

38.  Animal Orthopedics as a Human Model  Animals are used as human models in clinical studies or experiments in the development of surgical procedures & drugs in veterinary medicine to be used in human medicine.  Example:  The 1 st hip replacement surgery was developed in military dogs (German Shepherds have a genetic problem with hip joint being mis-aligned).

39. Protect Yourself  Osteoporosis is a bone disease where the bone mineral density is reduced.  Bones become much more fragile. People with osteoporosis are more likely to suffer fractures than people with normal bone density.  Reaching peak bone mass when young greatly reduces your risk of developing the disease.

40.  Physicians recommend that adolescents get 30 minutes of exercise everyday of the week.  Be sure children and teens are getting the recommended 1300 mg of calcium a day.  Eating a balanced diet and exercising will keep you agile, make you strong, and reduce your risk of developing many serious diseases later in your life. How to Strengthen Your Bones

41.  Osteoarthritis is deterioration or loss of the cartilage that acts as a protective cushion between bones, particularly in weight-bearing joints such as the knees and hips.  Treatment: Injection of anti- inflammatory drugs into arthritic joints reduces inflammation and pain.  Problem?: Drug effect doesn’t last, because drug diffuses out of the joint quickly. Effect could last longer if drug were held in the joint. Current NIH Research Topic: Sustained-Release Drug Carrier for Treatment of Osteoarthritis

42.  Researcher Lori A. Setton at Duke University designed a protein to inject along with the drug.  This modified and injectable arthritis drug remains at the site of the injection and forms a “drug depot”.  When studied in a rat knee joint model, the delivered protein/drug combination remained in the joint 25 times longer than the comparable soluble drug on the current market. Solution

43.  Today we learned:  What is orthopedics?  What are bones?  How to classify bones  Fractures!  How to repair a fracture  A quick look at current research involving bones  All of this information is true for people and pets! What we have covered!